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Relationship Between Type 2 Diabetes and White Matter Hyperintensity: A Systematic Review

Dan-Qiong Wang1,2, Lei Wang1, Miao-Miao Wei2

  • 1Department of General Medical, Shanxi Bethune Hospital Shanxi Academy of Medical Sciences, Taiyuan, China.

Frontiers in Endocrinology
|January 7, 2021
PubMed

Insights

Type 2 diabetes (T2DM) is linked to more white matter hyperintensities (WMH), impacting brain structure and cognitive function. This review highlights T2DM

Area of Science:

  • Neurology
  • Endocrinology
  • Radiology

Background:

  • White matter (WM) disease is a significant factor in cognitive decline and dementia.
  • White matter lesions (WMLs), visualized as white matter hyperintensities (WMH) on MRI, are increasingly studied in relation to systemic diseases.
  • Type 2 diabetes mellitus (T2DM) has been previously associated with WMH, necessitating a focused review of current evidence.

Purpose of the Study:

  • To systematically review the literature on the association between T2DM and WMH.
  • To explore the relationship between T2DM presence, its progression, complications, and WMH.
  • To investigate the links between T2DM-related brain structural changes, cognitive function, and WMH.

Main Methods:

  • Literature search conducted in PubMed and Cochrane databases.
  • Focus on studies published within the last five years.
  • Review and synthesis of findings on T2DM, WMH, and cognitive outcomes.

Main Results:

  • Most studies indicate larger WMH volume and reduced WM integrity in T2DM patients.
  • Cognitive deficits in memory, attention, and executive functions in T2DM correlate with observed brain structural changes.
  • Diabetic microangiopathy and peripheral neuropathy are potential contributors to WMH, implicating the brain as a target organ.
  • Insulin resistance, fasting insulin, high HbA1c, and high glucose variability are associated with WMH, whereas overall glycemic control is not consistently linked.

Conclusions:

  • T2DM is significantly associated with increased WMH and impaired white matter integrity.
  • WMH in T2DM patients contribute to cognitive decline, particularly in executive functions and memory.
  • Diabetic complications like microangiopathy may directly affect brain white matter, underscoring the systemic impact of T2DM.
Keywords:
cognitive functionmicroangiopathy and neuropathymicroscopicrelationshiptype 2 diabetes mellituswhite matter hyperintensities

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